Peters R, Macmathuna P, Lombard M, Karani J, Westaby D
Institute of Liver Studies, King's College Hospital and Medical School, London.
Gut. 1992 Oct;33(10):1412-5. doi: 10.1136/gut.33.10.1412.
Endoscopic placement of a biliary endoprosthesis has been proposed for the management of choledocholithiasis when stone extraction is difficult or considered hazardous. Over a two year period this approach was used in 40 such patients. There were 24 women and 16 men with a median age of 76 years. In seven patients with severe cholangitis no attempt was made to extract the stones. Twenty three (57.5%) patients underwent a sphincterotomy and four (10%) needle knife papillotomy. The endoprosthesis insertion was considered a temporary measure in 13 (32.5%) patients and definitive treatment in 27 (67.5%). Bile duct drainage was established in all patients. Early complications occurred in six patients (15%), but were without sequelae. Late complications developed in eight (20%) of the patients and included biliary colic (four), cholangitis (three), and cholecystitis (one). Two patients (one cholangitis and one cholecystitis) died as a consequence of the complication. Only patients without a sphincterotomy developed cholangitis. A total of eight patients (20%) underwent surgery (one as an emergency) and nine a repeat endoscopic retrograde cholangio pancreatography (two as an emergency) to clear the duct. The remaining 23 patients are asymptomatic at a median of 13 months (range five to 24 months). Biliary endoprosthesis insertion for choledocholithiasis is an important alternative means of establishing drainage in selected cases, and is probably the optimum method of management for the elderly and or debilitated patients with previous cholecystectomy. Caution must be exercised, however, in patients with an in situ gall bladder.
当结石取出困难或被认为有风险时，有人提出采用内镜下放置胆道内支架来处理胆总管结石。在两年时间里，对40例此类患者采用了这种方法。其中有24名女性和16名男性，年龄中位数为76岁。7例重症胆管炎患者未尝试取石。23例（57.5%）患者接受了括约肌切开术，4例（10%）患者接受了针刀乳头切开术。13例（32.5%）患者的内支架置入被视为临时措施，27例（67.5%）患者被视为确定性治疗。所有患者均建立了胆管引流。6例患者（15%）出现早期并发症，但无后遗症。8例（20%）患者出现晚期并发症，包括胆绞痛（4例）、胆管炎（3例）和胆囊炎（1例）。2例患者（1例胆管炎和1例胆囊炎）因并发症死亡。仅未行括约肌切开术的患者发生了胆管炎。共有8例患者（20%）接受了手术（1例为急诊手术），9例患者接受了重复内镜逆行胰胆管造影（2例为急诊造影）以清理胆管。其余23例患者在中位时间13个月（范围5至24个月）时无症状。对于胆总管结石，内镜下放置胆道内支架是在特定病例中建立引流的重要替代方法，可能是有过胆囊切除术的老年和/或体弱患者的最佳处理方法。然而，对于胆囊仍在原位的患者必须谨慎。
